A watercolor painting of a dog with Cushings disease next to a bowl of food.

What is Hyperadrenocorticism (Cushing’s Disease) in Dogs?

What is it?

Cushing’s disease in dogs is a condition caused by overproduction of the hormone cortisol, which is produced by the adrenal glands. The condition can occur naturally or be caused by prolonged use of steroids. Diagnosis of Cushing’s disease typically involves blood tests, urine tests, and imaging studies.

How is it Treated?

Treatment for Cushing’s disease in dogs depends on the underlying cause and the severity of the condition. In cases of adrenal tumors, surgery may be recommended to remove the tumor. Other treatment options may include medication to regulate cortisol production or manage symptoms, as well as dietary changes and exercise to maintain overall health.

Breed Predispositions

Poodles Dachshunds Boxers Terriers (Yorkshire, Boston, West Highland White) Beagles Labrador Retrievers German Shepherds Golden Retrievers

Introduction

For months, Jennifer had been observing some unusual changes in her loyal Boston Terrier, Bella. She noticed that Bella had developed a pot-bellied appearance, was losing hair, and seemed to be constantly hungry and thirsty. Concerned about her canine companion’s well-being, Jennifer scheduled a visit to her veterinarian. After a series of tests, the vet delivered the unexpected news that Bella had Cushing’s Disease, a condition Jennifer had never encountered before.

Cushing’s disease, hyperadrenocorticism, is a serious and complex condition that primarily targets middle-aged and older dogs. This disease is a pivotal catalyst for the overproduction of cortisol, a hormone playing a central role in regulating the body’s responses to stress, upkeeping cardiovascular health, counterbalancing insulin effects, and managing the immune system’s inflammatory response.

Cortisol, integral to a dog’s well-being, is produced and dispensed by the dog’s adrenal glands, strategically located near the kidneys. Dogs suffering from Cushing’s syndrome, especially pituitary-dependent Cushing鈥檚 disease, exhibit adrenal glands in overdrive, releasing an excessively high amount of this crucial hormone. Different triggers can spur this overproduction, leading to multiple variations of the disease, which includes pituitary-dependent Cushing’s disease.

Due to the abnormal increase in cortisol levels resulting from pituitary-dependent Cushing’s disease or other forms, the disease can induce systemic changes within a dog’s body, affecting numerous organs. This occurs due to the alteration in the dogs’ adrenal glands’ functioning. Consequently, this disease can seriously impact a dog’s quality of life and instigate severe health complications if left untreated.

The Three Types of Cushing’s Disease in Dogs

Cushing’s disease, also known as hyperadrenocorticism, is a condition in dogs characterized by an overproduction of the hormone cortisol. The disease is typically divided into three different types based on its root cause:

  1. Pituitary-dependent Cushing’s disease (PDH): This is the most common form, accounting for about 80-85% of cases. It is caused by a benign tumor in the pituitary gland at the base of the brain, which overstimulates the adrenal glands to produce excess cortisol.
  2. Adrenal-dependent Cushing’s disease (ADH): This type accounts for around 15-20% of cases and is caused by a tumor in one or both of the adrenal glands, located near the kidneys. This tumor leads to an overproduction of cortisol.
  3. Iatrogenic Cushing’s disease: This is the least common type and occurs as a side effect of long-term treatment with corticosteroid medications, used to treat conditions like allergies or autoimmune diseases. The excess of these medications mimics the effects of increased cortisol, leading to symptoms of Cushing’s disease.

Each of these types of Cushing’s disease has unique implications for treatment and management, so accurate diagnosis is crucial.

Causes of Cushing’s Disease in Dogs

Cushing’s disease in dogs, known as hyperadrenocorticism, primarily arises from three scenarios. Each causes an overproduction of cortisol, a steroid hormone integral to several processes such as immune response, stress regulation, and metabolism.

Pituitary Gland Tumor: The Culprit Behind Pituitary Dependent Cushing’s

The most common instigator of Cushing’s disease in dogs is a tumor within the pituitary gland at the base of the brain. This tumor, typically benign, produces excessive adrenocorticotropic hormone (ACTH). This overproduction induces the adrenal glands to release an overabundance of cortisol, leading to what’s known as pituitary-dependent Cushing’s disease. This condition often leads to an increased risk of urinary tract infections due to changes in cortisol levels.

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Adrenal Gland Tumor: The Underlying Cause of Adrenal Dependent Cushing’s

Another key contributor to Cushing’s disease is an adrenal gland tumor. These tumors can be benign or malignant, resulting in the adrenal glands near the kidneys producing too much cortisol. This adrenal-dependent Cushing’s disease can, over time, cause kidney damage due to excessive cortisol levels.

Prolonged Use of Corticosteroid Medications: The Iatrogenic Cause

In some instances, Cushing’s syndrome can be traced back to the prolonged use of corticosteroid medications prescribed for other health issues, such as gastrointestinal disease, inflammation, or allergies. These medications, used to suppress immune system disorders or chronic inflammatory liver disease, can lead to an iatrogenic form of Cushing’s. This form can be reversed by closely managing and adjusting the medication dosage under a veterinarian’s guidance. This careful control helps regulate the dog’s cortisol level, effectively reducing the symptoms and causes of Cushing’s disease in dogs.

cushing's disease in dogs

Symptoms of Hyperadrenocorticism in Dogs

Cushing’s disease in dogs often displays symptoms that appear gradually over many years, developing subtly and often unnoticed. However, in some instances, signs of Cushing鈥檚 disease can manifest abruptly and unexpectedly. The following list highlights the most commonly observed symptoms in dogs affected by this condition:

  • Elevated thirst and subsequent increased urination
  • A surge in appetite
  • Frequent panting
  • A distinctive pot-bellied appearance
  • Altered skin condition
  • Pronounced muscle weakness and persistent fatigue
  • Frequent occurrences of infections

These symptoms, which could lead to adverse reactions such as a blood clot, require prompt attention and possibly emergency care from a veterinarian. Based on the severity of these clinical signs and the extent of organ damage, the vet will suggest a suitable treatment strategy.

Diagnosis of Cushing’s Disease in Dogs

Diagnosing Cushing’s disease in dogs requires a comprehensive process. Internal medicine professionals employ a thorough physical examination and a range of laboratory tests, including a “blood test,” adrenal function tests, and sometimes even imaging studies to determine this disease.

Detailed Physical Examination and Medical History

The initial step in diagnosing Cushing’s disease encompasses an extensive physical examination and a thorough review of the dog’s medical history. Veterinarians typically enquire about the dog’s observable symptoms and the duration these symptoms have persisted. Physical examination may reveal telltale signs, such as a pot-bellied appearance, excessive panting, and skin changes common in dogs diagnosed with Cushing’s disease.

Laboratory Tests: Complete Blood Panel and Urinalysis

The second step involves laboratory tests, including a complete blood panel and urinalysis. Dogs with Cushing’s disease often exhibit changes in their blood cells and chemistry, revealed through abnormalities like high cholesterol, high blood sugar, and elevated liver enzymes that may indicate gallbladder disease. In addition, urinalysis can detect diluted urine, a common marker of Cushing’s disease.

Hormone Tests: ACTH Stimulation Test

Since Cushing’s disease impacts the hormone-producing glands, specific hormone tests are integral in the diagnostic process. For example, the ACTH stimulation test is routinely used to detect elevated cortisol levels in dogs, a definitive indicator of Cushing’s disease.

Imaging Studies

When the previous diagnostic steps indicate Cushing’s disease, imaging studies such as ultrasound are considered. Ultrasounds help visualize the adrenal glands and determine the presence of a tumor in either the adrenal or pituitary gland, confirming the diagnosis and form of Cushing’s disease.

Additional Diagnostic Tests: High Dose Dexamethasone Suppression Test

Additional tests like the high-dose dexamethasone suppression test or endogenous plasma ACTH concentration determination may be required if the diagnosis is still ambiguous. Veterinarians may also recommend specific advanced imaging techniques, such as CT or MRI scans, particularly when a pituitary gland tumor is suspected.

A veterinarian will recommend treatment based on the severity of clinical signs and the extent of organ damage. Treatment options include surgery to remove the affected part of the brain, radiation therapy, and medications. Medications typically consist of drugs called corticosteroids, which reduce inflammation and slow down cell division.

Treatment for Canine Cushing’s Disease

Treating Cushing’s disease in dogs primarily involves managing the hormone imbalance, typically achieved through medications, surgery, or radiation therapy. The best treatment approach depends on several factors, including the specific type of Cushing’s disease (pituitary or adrenal) and the dog’s overall health.

Medication

Medication is often the first line of treatment for dogs with pituitary-dependent Cushing’s disease and is also used when surgery is not an option for adrenal tumors. Two commonly used drugs are Trilostane and Mitotane.

Trilostane works by inhibiting the enzyme involved in the production of cortisol, thereby reducing cortisol levels. On the other hand, Mitotane destroys the layers of the adrenal gland that produce cortisol. Both these medications require regular follow-ups and blood tests to ensure the correct dosage and to monitor the dog’s response.

dogs at the vet clinic

Surgery

Surgery is an option for dogs with an adrenal gland tumor. The procedure involves removing the affected adrenal gland. It’s a more invasive approach, but it can cure the disease if the tumor is benign and hasn’t spread. However, the operation is complex and can have significant risks, so a specialist veterinary surgeon typically performs it.

Radiation Therapy

Radiation therapy can also be considered, especially for pituitary-dependent Cushing’s disease. This therapy targets the pituitary gland tumor with high-energy radiation to kill the tumor cells and reduce the tumor size.

Regardless of the chosen treatment method, dogs with Cushing’s disease need lifelong management and regular check-ups since the disease can’t be entirely cured but can be effectively managed. Pet owners must work closely with their veterinarians to monitor their dog’s condition and adjust the treatment plan. The goal of treatment is to minimize the symptoms and improve the quality of life for the affected dog.

Prevention of Cushing’s Disease in Dogs

Understanding and managing Cushing’s disease in dogs can be complex, but pet owners with adequate knowledge can play a vital role in their pet’s health. Here are some strategies that may help prevent Cushing’s or mitigate its effects:

  1. Balanced Diet: Ensuring your dog consumes a well-balanced diet suitable for their age, breed, size, and existing health conditions is crucial for overall wellness. This approach is the first line of defense in fostering a robust immune system, reducing the risk of ‘false positives when another disease’ with similar clinical signs is present.
  2. Regular Exercise: Regular physical activity aids in maintaining an ideal weight for your dog and promotes overall health. Given that obesity can lead to a multitude of health issues and potentially exacerbate conditions like Cushing’s disease, exercise is key. Particularly for ‘dogs with adrenal tumors,’ maintaining an active lifestyle can be beneficial.
  3. Regular Vet Check-ups: Routine veterinary check-ups help detect potential health issues at an early stage. This early detection is essential as some dogs may exhibit ‘disease with similar clinical signs’ to Cushing’s, requiring different treatment. ‘Adequate monitoring’ can lead to prompt and accurate treatment, improving outcomes.
  4. Monitor Medications: ‘Vets explain what causes’ some instances of Cushing’s disease, and one notable factor is the long-term use of specific medications like corticosteroids. Therefore, if your dog is on these medications, managing them under your vet’s guidance is crucial, including using the lowest effective dose and monitoring for side effects.
  5. Awareness: ‘Know about Cushing鈥檚 disease’ by familiarizing yourself with its signs and symptoms. Early detection is paramount for managing this disease effectively, improving your dog’s prognosis and quality of life, and reducing the chances of ‘the recurrence of the disease.’

While these strategies may not guarantee the prevention of Cushing’s disease, they contribute significantly to your dog’s overall health and vitality, which could lessen the likelihood of numerous health conditions, including Cushing’s. Always consult your vet if you have concerns about your dog’s health.

Frequently Asked Questions

Yes, a veterinarian should regularly monitor dogs on thyroid hormone replacement therapy. Monitoring is necessary to ensure the prescribed thyroid hormone medication is appropriate for the dog’s needs. Over time, the veterinarian may need to adjust the dosage based on the dog’s response and bloodwork results.

Regular blood tests, including thyroid hormone level checks, are commonly conducted to assess the dog’s thyroid function and make necessary dosage adjustments. Monitoring also allows the veterinarian to evaluate the dog’s overall health and address any potential complications or side effects associated with the medication.

The lifespan of a dog with an adrenal gland tumor can vary depending on several factors, including the type of tumor, its stage, the presence of metastasis (spread to other parts of the body), and the dog’s overall health. Adrenal gland tumors can be benign (non-cancerous) or malignant (cancerous), and the prognosis and life expectancy can differ. Malignant adrenal gland tumors generally have a poorer prognosis and shorter life expectancy than benign tumors. Some dogs may live several months to a few years with treatment, while others may have a shorter lifespan.

Cushing’s disease (hyperadrenocorticism) and Addison’s (hypoadrenocorticism) are two distinct hormonal disorders affecting dogs’ adrenal glands.

Cushing’s disease is characterized by excessive cortisol production, a hormone the adrenal glands produce. It can be caused by either an overactive adrenal gland (adrenal-dependent Cushing’s) or excessive production of adrenocorticotropic hormone (ACTH) by the pituitary gland (pituitary-dependent Cushing’s). Symptoms of Cushing’s disease in dogs include increased thirst and urination, weight gain, increased appetite, pot-bellied appearance, hair loss, and skin thinning.

On the other hand, Addison’s disease is characterized by insufficient production of cortisol and sometimes aldosterone, hormones produced by the adrenal glands. It is typically caused by autoimmune destruction of the adrenal glands. Symptoms of Addison’s disease in dogs include weakness, lethargy, decreased appetite, weight loss, vomiting, diarrhea, and sometimes collapse.

While Cushing’s disease involves excessive cortisol production, Addison’s disease involves insufficient cortisol production. Therefore, the treatment and management of these two conditions differ, as Cushing’s disease is usually treated with medication to suppress cortisol production. In contrast, Addison’s disease requires hormone replacement therapy to provide the deficient hormones. Proper diagnosis and treatment should be determined by a veterinarian based on the dog’s specific symptoms and diagnostic test results.

Dietary management is an important aspect of managing Cushing’s disease in dogs. Here are some dietary considerations for dogs with Cushing’s disease:

  1. Low-Fat Diet: Dogs with Cushing’s disease may have an increased risk of developing pancreatitis, so a low-fat diet is often recommended. Choose a dog food that is specifically formulated for dogs with pancreatitis or one that is labeled low-fat.
  2. Balanced Nutrition: Ensure your dog’s diet provides balanced nutrition with the right proportions of protein, carbohydrates, and fats. Look for high-quality dog foods that meet the nutritional requirements of dogs.
  3. Limited Carbohydrates: Some dogs with Cushing’s disease may have concurrent insulin resistance, so choosing a dog food that is low in carbohydrates or has complex carbohydrates that are slowly digested is beneficial.
  4. Controlled Sodium Intake: Dogs with Cushing’s disease may have an increased risk of developing hypertension (high blood pressure). Limiting the sodium intake in the diet can help manage blood pressure levels.
  5. Prescription Diets: In some cases, veterinarians may recommend specific prescription diets formulated for dogs with Cushing’s disease. These diets may have specific ingredients or formulations that aid in managing the condition.

It’s important to consult your veterinarian to determine the most appropriate diet for your dog with Cushing’s disease. They can provide specific dietary recommendations based on your dog’s needs and health status.

While muscle weakness or changes in mobility are not common symptoms of Cushing’s disease in dogs, some individuals may experience these issues. Excessive cortisol production associated with Cushing’s disease can lead to muscle wasting and weakness over time, challenging certain activities like walking or climbing stairs. Additionally, the disease can cause metabolic changes and electrolyte imbalances that may contribute to muscle weakness or affect the nervous system.

However, the severity of symptoms can vary, and not all dogs with Cushing’s disease will have significant mobility issues. Consulting with a veterinarian is recommended if you observe any changes in your dog’s mobility to ensure proper evaluation and appropriate management.

Cushing’s disease can affect the eyes in dogs, although it is not a common symptom. In some cases, the excessive cortisol production associated with Cushing’s disease can lead to changes in the eye, such as increased tear production or eye discharge. However, these eye-related symptoms are typically secondary to the underlying hormonal imbalance and may not be the primary focus of the disease. In addition, it’s important to note that eye-related symptoms can have various other causes. So, if you notice any abnormalities or changes in your dog’s eyes, it’s best to consult a veterinarian for a proper evaluation and diagnosis.

The progression of Cushing’s disease in dogs can vary depending on the underlying cause and individual factors. In some cases, it can develop slowly over months or even years, while in others, it may progress more rapidly. The symptoms of Cushing’s disease can also fluctuate, with periods of worsening and improvement. If left untreated, the disease can gradually worsen over time.

However, with proper management and treatment, the progression of Cushing’s disease can be slowed down, and dogs can experience an improved quality of life. Regular monitoring and veterinary care are important to assess the progression of the disease and adjust the treatment plan accordingly.

Cushing’s disease can develop in dogs at various ages but is more commonly seen in middle-aged to senior dogs. Typically, dogs between the ages of 7 and 12 years are more prone to developing Cushing’s disease. However, it can occur in dogs as young as one year and older. It’s important to note that the underlying cause of Cushing’s disease can also influence the age of onset.

For example, pituitary-dependent Cushing’s disease is more common in older dogs, while adrenal-dependent Cushing’s disease can occur in younger dogs. If you suspect your dog may have Cushing’s disease, it’s best to consult with a veterinarian for an accurate diagnosis and appropriate management.

Cushing’s disease can occur in dogs of any breed, but certain breeds are more prone to developing the condition. These breeds include Poodles, Dachshunds, Boston Terriers, Boxers, Beagles, Yorkshire Terriers, and German Shepherds. However, it’s important to note that Cushing’s disease can affect dogs of any breed or mixed breed. While breed predisposition may increase the risk, it does not mean all dogs of those breeds will develop Cushing’s disease.

Other factors such as age, sex, and overall health can also contribute to the likelihood of developing the condition. If you suspect your dog may have Cushing’s disease, it’s best to consult with a veterinarian for an accurate diagnosis and appropriate management.

The life expectancy of dogs with untreated Cushing’s disease can vary depending on the individual dog and the severity of the condition. Without treatment, Cushing’s disease can lead to various complications and negatively impact the dog’s overall health and quality of life. In some cases, dogs with untreated Cushing’s disease may experience a shorter lifespan due to the effects of the disease on their organs and immune system.

However, it’s important to note that the progression and outcome of untreated Cushing’s disease can be unpredictable, and some dogs may live for several years with manageable symptoms. Therefore, seeking veterinary care and discussing treatment options if your dog is diagnosed with Cushing’s disease is highly recommended to provide the best possible care and improve their prognosis.

Cushing’s disease itself does not typically directly cause blindness in dogs. However, the prolonged effects of the disease, such as high blood pressure, diabetes, or secondary infections, can potentially lead to ocular complications and vision problems. Additionally, certain medications used to treat Cushing’s disease, such as corticosteroids, can have ocular side effects. Therefore, if you notice any changes in your dog’s eyes or vision, it is important to consult with a veterinarian for a proper evaluation and appropriate treatment.

Yes, Cushing’s disease can potentially cause urinary incontinence in dogs. The excess cortisol production associated with Cushing’s disease can lead to muscle weakness, including the muscles that control urination. This can result in involuntary leakage of urine or difficulty controlling urination.

However, it’s important to note that not all dogs with Cushing’s disease will experience incontinence, as the symptoms can vary between individuals. If you suspect your dog has Cushing’s disease and is experiencing urinary incontinence, it is recommended to consult with a veterinarian for proper diagnosis and management.

Cushing’s disease itself does not directly cause hearing loss in dogs. However, suppose the disease is left untreated or poorly managed. In that case, it can lead to various complications that affect the overall health and well-being of the dog, which could include issues with the ears and hearing.

For example, chronic infections or changes in blood circulation associated with Cushing’s disease could indirectly impact the ears and potentially contribute to hearing problems. Therefore, if you have concerns about your dog’s hearing, it is best to consult a veterinarian for a thorough evaluation and appropriate management.

Cushing’s disease in dogs can sometimes lead to changes in behavior, including increased irritability, restlessness, and even aggression. These behavioral changes may be related to the hormonal imbalances caused by the disease. However, it’s important to note that not all dogs with Cushing’s disease will exhibit aggressive behavior, and other factors, such as individual temperament and underlying health conditions, can also influence a dog’s behavior.

If you notice any significant behavior changes in your dog, it is advisable to consult with a veterinarian who can evaluate the situation and provide appropriate guidance and treatment options.

No, Cushing’s disease in dogs is not contagious. It is a hormonal disorder caused by an overproduction of cortisol, a hormone the adrenal glands produce. It cannot be transmitted from one dog to another. Cushing’s disease typically occurs due to various underlying factors, such as a pituitary gland or adrenal glands tumor, and an infectious agent does not cause it. While Cushing’s disease is not contagious, underlying conditions or diseases that may contribute to its development could be contagious or infectious.

Yes, Cushing’s disease in dogs can be associated with the development of tumors. The most common cause of Cushing’s disease in dogs is a benign tumor in the pituitary gland at the brain’s base. This tumor causes excessive adrenocorticotropic hormone (ACTH) production, which in turn leads to the overproduction of cortisol by the adrenal glands.

In some cases, Cushing’s disease can also be caused by an adrenal gland tumor, which is less common but benign or malignant. The presence of these tumors contributes to the disruption of normal hormone production and regulation in the body, resulting in the symptoms and complications associated with Cushing’s disease.

Cushing’s disease itself does not typically cause seizures in dogs. However, suppose the underlying cause of Cushing’s disease is an adrenal gland tumor, and that tumor grows and affects the brain or causes other neurological complications. In that case, seizures can occur as a result. Additionally, high levels of cortisol associated with Cushing’s disease can sometimes lead to electrolyte imbalances or other metabolic disturbances, which in rare cases may contribute to seizures.

Therefore, it’s important to work with a veterinarian to diagnose and treat Cushing’s disease properly and to monitor for any potential neurological symptoms or seizures that may require additional evaluation and management.

No, Cushing’s disease in dogs is not caused by stress. Instead, it is primarily caused by the excessive production of cortisol, a hormone normally produced by the adrenal glands. The most common form of Cushing’s disease in dogs is called pituitary-dependent Cushing’s disease, which is caused by a tumor in the pituitary gland that stimulates the adrenal glands to produce more cortisol.

Another less common form is adrenal-dependent Cushing’s disease, caused by a tumor in the adrenal glands. So, while stress can affect a dog’s overall health and well-being, it does not directly cause Cushing’s disease.

Yes, Cushing’s disease in dogs can increase the risk of developing diabetes. This is because excessive levels of cortisol, the hormone associated with Cushing’s disease, can interfere with the normal regulation of blood sugar levels in the body. Over time, this can lead to insulin resistance and impaired glucose metabolism, increasing the risk of developing diabetes mellitus. Therefore, monitoring blood sugar levels and managing the condition is important in dogs with Cushing’s disease to help prevent or manage diabetes.

Yes, Cushing’s disease in dogs can affect the kidneys. Elevated levels of cortisol associated with the disease can cause changes in kidney function and structure over time. These changes can include increased water intake and urination, electrolyte imbalances, protein loss in the urine, and potential damage to the kidney tissue. In some cases, Cushing’s disease can contribute to developing or worsening kidney disease or other kidney-related conditions. Therefore, regular monitoring of kidney function and appropriate management of Cushing’s disease are important to help support kidney health in affected dogs.

Pruritus, or itching, is not typically a common symptom of Cushing’s disease in dogs. However, in some cases, dogs with Cushing’s disease may develop secondary skin issues that can cause itching. These skin issues can arise due to changes in the immune system, hormonal imbalances, or increased susceptibility to infections. It’s important to note that itching can have various causes, and if your dog is experiencing persistent itching, it’s best to consult a veterinarian for a proper evaluation and diagnosis. They can determine the underlying cause of the itching and recommend appropriate treatment options.

The decision to euthanize a dog with Cushing’s disease is deeply personal and individual and should be made in consultation with a veterinarian. There is no specific timeline or set criteria for when euthanasia is necessary in Cushing’s disease cases. Factors such as the dog’s overall quality of life, progression and severity of symptoms, response to treatment, presence of other concurrent health issues, and the impact on the dog’s well-being should be considered.

For example, suppose the dog’s quality of life is significantly compromised, with unmanageable pain, severe complications, or a decline in overall functioning. In that case, euthanasia may be considered a humane option to prevent further suffering. It’s important to have open and honest discussions with your veterinarian to assess the situation and make the best decision for your dog.

Disclaimer: The information provided on this veterinary website is intended for general educational purposes only and should not be considered as a substitute for professional veterinary advice, diagnosis, or treatment. Always consult a licensed veterinarian for any concerns or questions regarding the health and well-being of your pet. This website does not claim to cover every possible situation or provide exhaustive knowledge on the subjects presented. The owners and contributors of this website are not responsible for any harm or loss that may result from the use or misuse of the information provided herein.

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